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I am not a professional at designing medical trials, and if some reader is, please step up.

In my unexpert opinon, there are two ways you could go. First, you need some objective and measurable thing to test ... e.g. fatigue level if you can figure out how to measure it, or walking ability, or the 6 pin hand coordination method.) I really don't want to test Relapse Rate. That is what all the drug trials did, and none of the drugs slowed progression, and since I have PPMS and have never had a Relapse in my life, this is not attractive to me.)

Then you take a bunch of test subjects and divide them randomly into test or control arms, treat the test arm and do not treat the control arm, and follow them long enough to comare the effect on whatever the measurable thing is.

Or you can treat everyone, and compare wilth historical data.

However, you are going to have some placebo effect on the treatment group, so they can be expected to do better than the untreated/historical group regardless, and I do not know what the placebo effect is. We might have a good number from all the drug tests, I don't know if that would translate over to a surgical procedure.

These are just my quick ideas. What else might we try? Does anyone know what the proposed trials are doing?

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See Dr. Sclafani's topic. He has been wrestling with this, and some good ideas have been suggested. I'm sure yours would be welcomed too. I think he is trying to take the CCSVI victim's point of view into account in his study design. He is doing this on-line dialogue while he waits for IRB approval of his trial.

I have already written this in other threads, but I think is a good idea, and I try to spread it... So sorry for repeating.

The only ethically possible way to have controls is to use the restenosis cases as such.

How to perform a clinical trial? Let's take a groupe of people. Perform angioplasty and then, measure EDSS or other semi-objective scale. Repeat measurements of EDSS periodically while testing their veins. Of course, do not tell them the status of their veins.

After a given amount of time you only have to compare their reported EDSS with their restenosis. You will not prove that CCSVI is the cause of MS, but you will prove that blood flow affects the EDSS of MS patients. Enough to request the therapy for everybody.

Besides, you will also get an estimation of the time that a restenosis takes to create problems.

Billmeik wrote:di you guys see the scientific american article on ccsvi?

They proposed a trial like : 100 patients 50 get liberated 50 get a placebo liberation. or some kind of incision that does nothing.

they are followed and reported on.

I think canadians should volunteer for it.May be the only way to move forward.

I read SciAm every month, generallhy cover to cover and do not remember seeing it. What month, and what section of the magazine?

By the way, 1eye is right, that is an issue DrScalfini has been struggling with while awaiting IRB approval. His thread is somewhat daunting for those of us that have not been following it all along. I may go back and try to synthasize the entries on this subject.

I personally think this is VERY IMPORTANT. The righ test done as soon as possible will either unleash the flood gates or put this very hot issue to bed if it is not the real deal.

I agree with you, Fogdweller, about the importance of the design. I was recently speaking with a vascular surgeon (who refused to treat CCSVI for lack of evidence) about a trial design. He thought that the only way to do it, and how they've done things in the past, is to have an independent 3rd party observer examine patients. The observer would observe them before and after the treatment, but he wouldn't no who had actually been treated.

I think a problem with this is, again, how to measure subjectively reported improvements, such as fatigue and cogfog improvements. With a 3rd party observer, subjective reports of improvement would be meaningless.

I was really worried that this would be accepted as the test and, since the majority of previously reported improvements would not be caught, the treatment would fail for lack of efficacy.

I think that this just shows the importance of having neurologists involved. They know the full range of debilitating effects of MS (the good neurologists, anyway).

--334 patients with EDSS less than 3 in open label treatment of Campath or Beta interferon

--blinded neuro doing assessment

the patient knows what they got but they are testing for lesion burden and relapses and edss so it is thought that the blinded neuro can be objective without a placebo control.
marie

I'm not offering medical advice, I am just a patient too! Talk to your doctor about what is best for you...http://www.thisisms.com/ftopic-7318-0.html This is my regimen threadhttp://www.ccsvibook.com Read my book published by McFarland Health topics

Found it too. It is on the web site and not in the magazine, I guess. Not a bad article. However, it says they need to do a study where both patients and doctors are unaware of who has had the treatment. It gives no idea of how to do that. I still do not think it is possible.

I think with surgey (or IR intervention) it is not possible for the patient to not know who has been treated. I think the sugesstion above, that observers that are unaware of the who was treated or not do the scoring on improvement may be the best we can do.

That is sort of what Zamboni did with the CCSVI veionograms. He had them read by third parties that did not know who had MS and who did not, and thus his determination that the CCSVI was mostlly present in the MS patients had some real weight with me. However, in that case the people taking the veinograms knew. In Buffalo they made an effort to hide this as well, so the results were even more legiltimate.

The placebo effect, which is real, means that those MS patinets who are treated will improve even if the tester does not know which ones were treated. And I think this is not just a subjective matter but will also affect even the objective factors like MRIs. I am not real sure of this last issue. I hope someone a bit more informed of the placebo effect will chime in, but we shouls be able to account for that effect in analyzing the results.

Istituto Neurologico C. Besta, Milano, Italy.AbstractTo verify whether the outcome in placebo-treated MS patients actually corresponds to that expected on the basis of the natural history and pretrial evolution of the disease, we here review the results of clinical trials conducted according to a placebo-controlled, randomized design, regardless of the experimental therapy used. The frequency of relapse in remitting-relapsing patients decreases during follow-up, and disability in progressive cases increases more slowly than before enrollment. These data should be borne in mind when evaluating the impact of experimental drugs on the natural course of the disease.

http://www.ncbi.nlm.nih.gov/pubmed/8797067Decrease of relapses and disability both sound like objectively measured things, so we're not just talking placebo/not real but placebo/has an objective effect, I think.

"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition

Istituto Neurologico C. Besta, Milano, Italy.AbstractTo verify whether the outcome in placebo-treated MS patients actually corresponds to that expected on the basis of the natural history and pretrial evolution of the disease, we here review the results of clinical trials conducted according to a placebo-controlled, randomized design, regardless of the experimental therapy used. The frequency of relapse in remitting-relapsing patients decreases during follow-up, and disability in progressive cases increases more slowly than before enrollment. These data should be borne in mind when evaluating the impact of experimental drugs on the natural course of the disease.

Good find. My point, even objective factors are decreased per placebo. I was talking to a neuro who said that all the drug trials seemed to be about 35-40% reduction and he thought that might not be real. However those were double blind studies, so whatever their placebo effect, that could give us a number to use. (a placebo effect.)Decrease of relapses and disability both sound like objectively measured things, so we're not just talking placebo/not real but placebo/has an objective effect, I think.

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